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Depressed skull fractures in children secondary to skull clamp fixation devices
1Division of Pediatric Neurosurgery, New York University Medical Center, New York.
Insights
Skull clamp fixation devices are generally safe in neurosurgery but require caution in pediatric patients. This study identified 5 pediatric cases of depressed skull fractures from skull clamps, necessitating further procedures.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Cranial Surgery
Background:
- External skull fixation devices (skull clamps) are standard in adult neurosurgery.
- The safety and complications of skull clamps in pediatric patients are not well-documented.
- Pediatric neurosurgery presents unique challenges due to developing bone structures.
Abstract:
The use of external skull fixation devices (skull clamps) is a common practice in neurosurgery. The insertion of pins into the skull is usually routine and uneventful in adult patients. However, the safety of skull clamp fixation devices in children is not reported. We have examined our complications over the past 6 years, and have encountered 5 children with depressed skull fractures secondary to application of a skull clamp fixation device. There were 3 boys and 2 girls with ages ranging from 3 to 8 years (mean 5.8 years). Two patients had brainstem gliomas, 2 patients had hypothalamic gliomas and 1 patient had a medulloblastoma. Four of the children required separate cranial procedures for exploration and elevation of the depressed fractures. There were no sequelae associated with the depressed fractures. We conclude that skull clamp fixation devices are safe, but should be used with caution in the pediatric patient. In addition, we present several modifications of existing skull clamps which may decrease the risk of depressed skull fractures.